CONGENITAL MALARIA: PREVALENCE AND OUTCOME AS SEEN AT USMANU DANFODIYO UNIVERSITY TEACHING HOSPITAL, SOKOTO

Abstract

There was a body of evidence that suggested that the prevalence of congenital malaria was
on the increase. As a result the actual prevalence could have been much higher than what had been
reported in the literature. There were also conflicting reports on the clinical significance of
congenital malaria. Symptoms were reportedly rare in some studies, while in other studies, they
mimicked symptoms of neonatal sepsis. The aim of the present study was to determine the
prevalence, the clinical manifestations, the risk factors and the outcome of congenital malaria at
Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto.
Consecutive mother-neonate pairs seen between February 1st and July 28th 2014 were
recruited for the study at the time of delivery. Maternal data such as age, parity, booking status, use
of ITN, administration of IPTp and HIV status were collected. Other data collected included
spouses’ educational qualification and occupation. The birth weight, length and Apgar scores of the
neonates were also documented. Blood samples were obtained from placenta, cord, peripheral blood
of neonates and their mothers. The diagnosis of congenital malaria was based on identification of
asexual forms of malaria parasite in cord blood or peripheral blood of neonates at birth, using
giemsa stain and microscopy. The babies with parasitaemia were observed for at least 48 hours for
clinical features. Malaria parasite was also done for the neonates with parasitaemia at 24 hours
interval until parasite clearance was achieved. Neonates with clinical features were screened for
sepsis and where investigations were suggestive or confirmatory of bacterial infection, they were
treated with antibiotics based on sensitivity pattern. Neonates with malaria parasitaemia and clinical
features and neonates with malaria parasitaemia at 48th hour of life irrespective of symptoms were
treated with artemetherlumefantrine or intravenous artesunate. Four hundred neonates were studied, 162 (40.5%) had congenital malaria out of which 40
(24.7%) developed symptoms. The commonest symptom was fever. One hundred and twentytwo
(75.3%) of the 162 neonates with congenital malaria had spontaneous parasite clearance within 48
hours of life. Symptomatic neonates developed symptoms within 48 hours of life, and responded to
treatment with intravenous artesunate and or artemether-lumefantrine with resolution of symptoms
and parasite clearance within 48 hours of commencement of treatment.
Congenital malaria was strongly associated with low socioeconomic class, low parity, maternal
HIV infection and maternal parasitaemia. Three (1.9%) neonates died out of the 162 neonates with
congenital malaria within 48 hours of life. However, the causes of death in these neonates were not
likely to be related to malaria.
In conclusion, the prevalence of congenital malaria in the present study was high, and
clinical features were similar to those of neonatal sepsis. It is therefore recommended that newborns
with features suggestive of sepsis should be screened for congenital malaria and sepsis, and positive
cases treated.

CONGENITAL MALARIA: PREVALENCE AND OUTCOME AS SEEN AT USMANU DANFODIYO UNIVERSITY TEACHING HOSPITAL, SOKOTO